II. Epidemiology
- Prevalence: 30-60% of HIV patients
III. Types
- Distal Sensory Polyneuropathy (most-common HIV-associated Neuropathy)
- Common complication at any stage of HIV Infection
- Risk Factors
- Low CD4 nadir (esp. <200 cells/uL)
- Antiretroviral therapy >6 months
- Varicella Zoster Virus (VZV) commonly involved
- Toxic Peripheral Neuropathy
- HIV Treatment with nRTI agents, especially older agents (e.g. Stavudine, Didanosine)
- Demyelinating Neuropathy
- Resembles Guillain-Barre
- Seen in early HIV
- Ascending sensorimotor Neuropathy with Incontinence or polyradiculopathy
- Cytomegalovirus (CMV) infection
- May involve the spinal cord segment
- May present with a painful extremity
- Cytomegalovirus (CMV) infection
IV. Symptoms: Distal Sensory Polyneuropathy
- Distal lower extremity numbness, Paresthesias, or pain
V. Signs: Distal Sensory Polyneuropathy
- Decreased ankle Deep Tendon Reflexes
- Decreased lower extremity Sensation (esp. sharp and vibratory Sensation)
VI. Differential Diagnosis
VII. Management
- See Peripheral Neuropathy
-
General measures
- Lifestyle (e.g. Exercise)
- Eliminate Neurotoxins (e.g. older Antiretroviral agents)
- Control comorbidities (e.g. Diabetes Mellitus, Alcohol Abuse)
- Reduce HIV Viral Load
- Symptomatic management
- Gabapentin (Neurontin)
- Capsaicin patches
- Tricyclic Antidepressants
- Alpha-lipoic acid
- Avoid Lamotrigine (low efficacy)